P1687: LIFE AFTER CAR T-CELLS: DO PATIENTS RECOVER A NORMAL LIFE?
Authors: Alya Perthus, Fanny Colin, Emilie Charton, Amelie Anota, Sophie De Guibert, Loïc Ysebaert, Pierre Daufresne, Faustine Lhomme, Guillaume Manson, Adeline Bellec, Laetitia Le Bars, Thierry Lamy De La Chapelle, Roch Houot, Aline Moignet
Journal: HemaSphere (2023)

Topic: 35. Quality of life and palliative care Background: CD19 CAR-T cells have been approved for the treatment of relapse/refractory (R/R) lymphoma. Although CAR T-cells are able to induce prolonged remission (and potentially cure) in a significant number of patients, little is known about patients’ life after CAR-T cells. Here, we conducted a prospective study to evaluate health-related quality of life (HRQol), as well as physical, social and professional outcomes after CAR-T cell therapy. Aims: Primary objective was to describe HRQol changes during the first year after CAR-T cell treatment. Secondary objectives were to describe psychological factors and to evaluate satisfaction about normal life recovery. Methods: This prospective study was conducted at the University Hospitals of Rennes and Toulouse (France). All adult patients with R/R lymphoma treated with CAR T-cells, including Axicabtagene ciloleucel (axi-cel), Tisagenlecleucel (tisa-cel) and Brexucabtagene autoleucel (brexu-cel), were eligible. HRQol changes were assessed using the FACT-Lym questionnaire. Other questionnaires evaluated cognitive state (FACT-Cog), fatigue (FACT-Fatigue), anxiety and depression (HAD scale), post-traumatic stress disorder (PTSD), and sexuality (VICAN). Questionnaires were collected at baseline (before leucapheresis), immediately before CAR-T infusion, 3, and 6 months after CAR T-cell infusion. Patients were censored in case of relapse or death. Among patients in remission after 12 months, professional, physical, social, sexual and global life information were collected. Results: From March 2020 to August 2022, 59 patients were included in the study, including 46 LBCL (78.0%), 5 MCL (8.5%) and 8 FL (13.5%). Median age was 63 years (range, 19-78). Patients were treated with axi-cel (n=37, 62.7%), tisa-cel (n=18, 30.5%) or brexu-cel (n=3, 5.1%). The median follow-up after CAR T-cell infusion was 11 months. At 3 months and 6 months respectively, there were 53 and 38 patients still in remission. The FACT-Lym score showed a clinically relevant improvement of HRQoL at 3 and 6 months after CAR T-cell infusion, with a mean change from baseline of 10.94 points (95%CI 5.83;16.05) and 12.16 (95%CI 4.19;20.12), respectively. The fatigue subscale showed a clinically relevant improvement at 3 and 6 months, with a mean change from baseline of 5.87 points (95%CI 2.93;8.8) and 4.70 (95%CI 0.2;9.2), respectively. The FACT-Cog score did not show any clinically relevant change for perceived cognitive impairments. The HAD score showed that 43% and 24% of patients presented anxiety and depression at baseline, respectively, versus 26% and 7% after 6 months. Overall, 26% of patients presented a significant PTSD (i.e. >44) at 6 months. Sexual life satisfaction improved from 30% at baseline to 50% after 6 months. After 12 months with a median follow-up of 19 months, 22 patients were in remission. Among the working age population (n=10), 50% patients returned to work in a median time of 9 months (range, 3-13). All patients practiced a physical activity again, although less intensively. Overall, 54% of patients felt less fit than before initial diagnosis. Three patients out of 8 (37.5%) return to their social activity. Most patients were satisfied with their sexual life (68.2%) and, in comparison with before initial diagnosis 59.1% considered that it was back to normal. Overall, 54.5% of the patients considered that their life was back to normal, i.e. similar to what it was before lymphoma diagnosis. These results are shown in the figure below. Summary/Conclusion: Our study shows an clinically significant improvement in HRQol after CAR-T cells therapy with an improvement in anxiety, depression, sexual satisfaction.. Nevertheless, half of the working age population returned to work and 54% considered their life back to normal.Keywords: Lymphoma, Quality of life, CAR-T